Identification of Older Adults at Risk for Falls with Drug-Based Indices
Purpose/Hypothesis: Falls in the older adult population are the leading cause of fatal and non-fatal injuries in America. Polypharmacy, the use of multiple medications, has been identified as a major risk factor for falls in older adults. A variety of medication screens exist that identify adverse effects of medications which can directly impact fall risk; however, current screening measures have limitations. The Quantitative Drug Index (QDI) is a new, clinically anchored index to quantify all potential adverse eﬀects associated with drug-mediated fall risk. The purpose of this study was to validate the QDI as a fall risk screening tool.
Number of Subjects: 138 adults were recruited from local senior centers and screened. Inclusion criteria: community-dwelling, age 60 to 89 years, and currently prescribed at least one medication. Exclusion criteria: progressive neurological disorders, unstable medical conditions, cognitive impairment, severe depression or anxiety, severe lower extremity impairment that would impact mobility, and severe vision impairment.
Materials and Methods: Mobility and balance outcome measures related to fall risk included: 30-second chair stand test, 10-meter walk test, Timed Up and Go (TUG) and Dynamic Gait Index (DGI). Self-report measures of fall risk included fall history, Fall Risk Questionnaire (FRQ) and Activity-specific Balance Confidence scale (ABC). The QDI was derived from each participant's medications. Participants were classified as either fallers or nonfallers based on self-report history of falls within the past year. Nonparametric Spearman’s Rho correlations were used to determine relationships between faller status and measures of fall risk. A receiver operating characteristic (ROC) curve analysis determined cutoff scores for outcome measures related to faller status.
Results: A fair to moderate relationship between the QDI and several physical performance and self-report measures was identified: FRQ (r=0.363), ABC (r=-0.401), DGI (r=-0.360). However, little to no relationship was found between faller status and QDI score (r=0.221). The ROC analysis determined the area under the curve for QDI was 0.63 with a cutoff score of 2.5 yielding sensitivity of 78% and specificity of 47%.
Conclusions: The development of the QDI was an interdisciplinary effort between pharmacists and physical therapists to screen for fall risk in older individuals. The QDI offers a better way to quantify the adverse effects of drugs on mobility compared with simple drug counts. The QDI alone does not identify individuals at fall risk; however, the QDI is significantly correlated to several measures of fall risk, including FRQ, ABC, and DGI. The ROC Curve Analysis identified a cutoff score for fall risk for the QDI which was found to have similar sensitivity and specificity to the TUG.
Clinical Relevance: The QDI could be incorporated into electronic medical records to identify patients who may be at fall risk and would be appropriate for further balance and mobility evaluation.
Hall, Courtney D.; Grieshaber, Emily; Hendricks, Blaine; Lewis, Kammie A.; McGrady, Seth A.; Morton, Megan Lea; Odle, Brian L.; and Panus, Peter C.. 2020. Identification of Older Adults at Risk for Falls with Drug-Based Indices. Combined Sections Meeting of the APTA, Poster 1327, Denver, CO. https://apta.confex.com/apta/csm2020/meetingapp.cgi/Paper/25354